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DH must play fair over pandemic that wasn’t

The average practice is set to lose £4,300 this year because of swine flu vaccination and low access survey scores - but the targets were agreed when the pandemic was thought much worse. It's time for a rethink to tackle this injustice

It is, as one GP leader told Pulse this week, going to be a tough old year. The economy remains bleak, GP pay is heading for a freeze as severe as the weather and practices are under intensive scrutiny over value for money. In his New Year forecast, RCGP chair Professor Steve Field is nevertheless determinedly optimistic that GPs will rise to the challenge, and he is right to be. GPs always do cope, and could even thrive if politicians get commissioning incentives right. But it's going to be a hard slog, and practices could have done without the headache of the swine flu vaccination campaign, with its questionable clinical benefits and uncertain rewards.

Of course GPs didn't take on swine flu vaccination for the money, whatever the Daily Mail may claim. But practices will not have expected to be left out of pocket either. So the news that most practices are falling short of the 50.7% target to qualify for relaxed thresholds on QOF access indicators, and that the swine flu outbreak appears to have hit performance on those indicators, is a heavy blow. The average practice is set to lose £4,300 in access pay compared with 2008/9, £1,000 more even than this financial year, when toughened PE7 and PE8 thresholds hit practices hard and left the profession in uproar.

GPs have been victims of factors completely out of their control. When GPC negotiators agreed the 50.7% target, they felt it was achievable but knew external factors could intervene. Deputy chair Dr Richard Vautrey warned a vaccine safety scare could ruin GPs' hopes of reaching the target. In the event, it has not been fears over vaccine safety that have done for practices, but the slow dawning that swine flu itself is nothing much to be scared about. Too many patients have simply not seen the point of vaccination. Not for the first time, GPs are left wondering why a Government that purports to believe in patient choice has left GP pay reliant on patients choosing one particular way.

The latest patient survey results clearly reveal why concessions on access were needed. Scores for April to September, covering the first swine flu peak, were down nationally by three points on PE7 and four on PE8, perhaps even more sharply in flu hotspots. GPs didn't have the pressures of a vaccine campaign to deal with then, either, and scores for the next six months could conceivably be even lower. It's hardly surprising – how can GPs be expected to deliver appointments as promptly as usual in the face of a pandemic?

The Government may be rubbing its hands that circumstances have so conspired against practices, and at savings in access payments of as much as £45m.

But if ministers are honest, they will acknowledge that the pandemic has not turned out as anyone expected, and that the access deal, even if agreed in good faith, has proven patently unfair. Stripping millions from practices will benefit nobody, least of all patients. The Government must scrap the requirement for GPs to hit 50.7% uptake to gain concession on access. It must relax survey thresholds for all GPs.

Fifty years of supporting GPs

It's easy to imagine that the current pressures on practices are unprecedented. But Pulse turns 50 this year, and a quick look at our archive reveals the past five decades have been littered with complex negotiations and angry disputes with government. If there's a lesson, it's that

GP morale has fluctuated over the years, but no politician can ever afford to let it get too low. GPs, as valued family doctors, will always hold the trump card.

Editorial comment Richard Hoey, editor